Hospital-Acquired Infections and Hand Hygiene: A Literature Review

This report addresses the critical clinical practice issue of infection control, specifically focusing on hand hygiene practices to combat hospital-acquired infections (HAIs). The introduction defines HAIs and their prevalence in healthcare settings, emphasizing the role of healthcare staff in their spread. The report summarizes and critiques three scholarly articles: Luangasanatip et al. (2015), Rodriguez et al. (2015), and Sadule-Rios & Aguilera (2017). The first article is a systematic review and meta-analysis, the second a quantitative study of a multimodal intervention, and the third a survey exploring nurses' perceptions. The critique utilizes the CASP tool to assess the articles' value, relevance, and trustworthiness. The findings reveal that interventions such as WHO-5 and multimodal approaches are effective in improving hand hygiene compliance, while factors like workload and staffing shortages hinder compliance. The report concludes by stressing the importance of hand hygiene in preventing the spread of pathogens and improving patient outcomes, highlighting hand hygiene as a cost-effective strategy to prevent HAIs.

Running head: CPI ISSUE
Introduction- Hospital acquired infection, also referred to as nosocomial infection
refers to that is acquired in healthcare settings and/or hospitals. These are also called health
care associated infections (HCAI or HAI) and are commonly prevalent in rehabilitation
facilities, nursing homes, hospitals, clinical settings, and different outpatient clinics. The
clinical practice issue identified in this assignment is infection control. Under such situations
the infection gets spread to susceptible patients staying in clinical settings by different means.
The health care staff are most responsible for the spread of infection due to their use of
contaminated surgical equipment, and via air droplets (Dancer, 2014). Clinical governance
refers to the system that makes the NHS organisations accountable and answerable for
continuous improvement of their service quality and protecting high care standards through
the creation of an environment that allows flourish of clinical care. Effective clinical
governance is essential to upkeep developments in infection control. It is within the outline of
monitored, assured and superior quality healthcare services that hospital workers in infection
control domain must progress their own approaches of implementing clinical governance.
Ceballos et al. (2013) stated that some of the common types of HAI namely, (i)
urinary tract infection (UTI), (ii) meningitis, (iii) pneumonia, (iv) gastroenteritis, and (v)
surgical site infections. The major symptoms of the infections often comprise of fever, cough,
shortness of breath, headache, nausea, diarrhoea, vomiting, and wound discharge. Bacteria,
virus and fungi have been identified as the primary reason for onset of nosocomial infections.
During their stay in hospitals, most patients are likely to get their immune system
compromised, thus increasing their susceptibility to get affected by HAI. Some of the
common bacteria that are responsible for these infection are Staphylococcus aureus,
Escherichia coli, Enterococci, and Pseudomonas aeruginosa. Recent evidences for the
transmission of HAI have focused on indwelling catheters as a major source of transmission
(Barbier et al., 2013).

Contact transmission is the most frequent mode of transfer of nosocomial infections
through direct contact between an infected person and a healthy person, or with contaminated
hands and medical instruments. This calls for the need to place a due focus on hand hygiene
techniques. Medical hand hygiene is a broad term that refers to hygiene practices that are
linked to medical procedures. Hand washing prior to the administration of medicine or care
services has the potential of preventing or minimizing the spread of infection by cleansing the
hands of different pathogens (Schumacher et al., 2013). This assignment will summarise
three pieces of scholarly literature on hand hygiene practices and will critically evaluate their
content.
Summary table
Article
s
Author/s
(year)
Country
Aims Sample/
setting
Design/
methods
Main
findings
Strengths and
limitations of
the paper
1 (Luangasanati
p et al.,
2015)/Thailan
d
To assess
the
comparativ
e
effectivenes
s of the
WHO 2005
campaign
(WHO-5)
and
different
Systematic
review that
retrieved
3639 articles,
of which
only 41 were
able to meet
the inclusion
criteria.
Meta-
analysis
Electronic
databases
such as,
Embase,
CINAHL,
Medline,
NHS Centre
for Reviews
and
Disseminatio
n, NHS
Meta-
analysis of
two RCTs
indicated
that adding
the goal
settings to
WHO-5 was
related with
enhanced
acquiescence
Strength: The
networked
meta-analysis
allowed the
quantification
of comparative
effectiveness
among
sequence of
several
interventions

intervention
s for
promoting
hand
hygiene
practices
among the
healthcare
workers
and to
abridge
related
information
on usage of
resources
conducted
for the
included
articles (1
non-RCT, 32
interrupted
time
research, and
2 before-
and-after
research)
Economic
Evaluation
Database,
EPOC
register, and
Cochrane
Library, were
used for the
extraction of
studies. The
search terms
were
obtained
from
previously
conducted
systematic
reviews.
(pooled odds
ratio 1.35,
95%
confidence
interval 1.04
to 1.76;
I2=81%). Of
the 22
pairwise
assessments
from
intermittent
time series,
18 were able
to
demonstrate
stepwise
upsurge in
compliance
with
practices
that focused
on hand
hygiene. 19
studies also
with varied
baseline
interventions.
Limitation:
Substantial
variation
intervention
components;
varied quality
of delivery of
different
studies.

reported
certain
clinical
outcomes
that were
dependable
on clinically
significant
decreases in
infection
rates,
ensuing
from
enhanced
hand
hygiene for
certain
hospital
pathogens.
2 (Rodriguez et
al., 2015),
Buenos Aries
To
determine
the
consequenc
e of
11 intensive
care units
(ICUs) from
Buenos
Aries,
Quantitative
study that
comprised of
a multimodal
intervention.
The study
recruited
705
contributors,
including
Strength:
Quantitative
research design
and
implementation

multimodal
involvemen
t on
enhancing
healthcare
workers’
acquiescenc
e to hand
hygiene
practices
Argentina.
The ICUs
were
considered
as such there
were special
equipment
present,
along with
trained
personnel,
besides
presence of
implemented
programs
that
monitored
and
prevented all
kinds of
HAIs.
This
particular
intervention
was planned
based on
practices
categorized
as low cost,
evidence-
based, and
recommende
d by
qualitative
research.
Some of the
key
components
were (i)
monitoring
materials
needed to
obey with
hand hygiene
practices and
alcohol
physicians
(25.8%),
nurses
(66.4%), and
other
healthcare
workers
(7.8%),
besides 9
months of
reflection.
Obedience
of hand
hygiene
practices in
the control
group was
found to be
66.0%
(2354/3565),
in
comparison
to 75.6%
(5190/6864)
of the
of an
intervention,
based on
recommendatio
n of evidences,
and previously
conducted
qualitative
research
Limitation:
Lack of
standardisation
of ICU roles
and regular
activities of the
site
coordinator.

intake, (ii)
leadership
commitment,
(iii) use of
reminders,
(iv) response
(v) a
storyboard of
the scheme,
and (vi) rate
of hand
hygiene
compliance.
intervention
group.
Univariate
analysis was
also
conducted
and
demonstrate
d an
association
between
hand
hygiene
compliance
and the
intervention
(odds ratio,
OR 1.17;
95%
confidence
interval (CI),
1.13–1.22).
3 (Sadule-Rios
& Aguilera,
Explore the
perceptions
47 nurses
working in
Exploratory,
descriptive
Nurses
nominated
Strength:
Explored the

2017)/ United
States
of nurses of
motives for
poor hand
hygiene
compliance
rates in the
Critical
Care Units
critical care
units were
recruited,
followed by
administratio
n of
questionnaire
s
survey
conducted in
452 bedded
Magnet
hospital,
followed by
descriptive
statistics with
SPSS 23.0
for analysing
the results
recommende
d absence of
time, high
workload
and
understaffin
g and major
problems
with hand
hygiene
acquiescence
. Trouble to
access sinks
and lack of
suitably
positioned
hand
sanitisers
were other
major
barriers.
thoughts and
perceptions of
nurses
Limitation:
One hospital
was selected
and only
critical care
nurses were
recruited

Critique of three articles- The CASP tool was used for critical appraisal of the three
articles. Use of the CASP tool helped in systematically and carefully examining and assessing
the consequences of the research evidences, with the aim of judging the value, relevance and
trustworthiness of the findings, in relation to the phenomenon being investigated (hand
hygiene practices) (Munn et al., 2014). All the three articles addressed a clearly focused
issue. This can be attributed to the fact that nosocomial infections threaten the health and
safety of the participants and might often prove fatal (Breathnach, 2013). The article by
Luangasanatip et al. (2015) employed an accurate research design. Conducting a systematic
review helped in collecting secondary data from several studies and also provided an
exhaustive summary of the current evidences that were relevant to the research question
(Moher et al., 2014). Use of the two step article extraction strategy was rigorous since it
helped in excluding literature that were not relevant to the research topic. Furthermore, the
network meta-analysis helped in combining direct and indirect evidences, thus drawing a
comparison of the effectiveness of all interventions that were implemented. Use of results
from high quality recent evidences was a correct approach in determining the effectiveness of
the interventions.
The second article by Rodriguez et al. (2015) was also accurate in addressing the
essential issue of hand hygiene improvement. The research design was appropriate since
recent evidences have provided adequate facts for supporting the high prevalence of
nosocomial infections in intensive care units (ICU) (Manzoni et al., 2013). Designing the
study in the form of a randomised controlled trial helped in making causal inferences and also
minimised chances of selection or allocation bias. Furthermore, data collection through focus
groups was another correct approach that established validity of the results. This can be
attributed to the fact that focus groups allowed exploring what the different groups of
healthcare workers thought or felt about a certain topic (hand hygiene compliance), by adding

a human dimension to the collected impersonal data (Cleary, Horsfall & Hayter, 2014).
Another correct approach was that the research design was also able to recommend strategies
that should be adopted for improving hand hygiene compliance rates across ICUs.
Sadule-Rios and Aguilera (2017) also adopted a correct approach in focusing the
research question on exploring the perception behind low rates of hand hygiene compliance
across healthcare settings. Use of an exploratory descriptive design was another accurate
method since it helps in establishing priorities of a research question that has previously not
been conducted. The research by Luangasanatip et al. (2015) was more rigorous since it
summarised a large body of scientific evidences based on hand hygiene intervention and
minimised bias, while reaching the research conclusions.
Findings- While the results presented by Luangasanatip et al. (2015) suggested that
complex hand hygiene intervention such as, WHO-5 and lone interventions that comprised of
training, system change, reminders, and education, were linked with enhanced agreement to
hand hygiene practices by healthcare workers, who were present in hospitals, compared with
typical practice. It was also suggested that addition of incremental interventions counting
reward incentives, goal setting, and answerability to the strategy of WHO-5 resulted in
further advances in compliance rates.
In contrast, Rodriguez et al. (2015) stated that infection control practices that focus on
hand hygiene are imperative in averting the incidence of health care associated infections and
also stated that multimodal practices that comprised of alcohol-based hand rub were better
effective than usual infection control measures. Significant increase in the rates of hand
hygiene practices during the intervention period suggested that the intervention was
successful in increasing the knowledge and awareness among the healthcare workers on
preventing transmission of pathogens. However, 98% hand rubs use suggested adherence to

the method, prior to conduction of the study. Thus, the findings were able to establish the
effectiveness of multimodal intervention for improving hand hygiene practices.
On the other hand, Sadule-Rios and Aguilera (2017) suggested lack of adequate
healthcare workers and subsequent workload as the basic factors that were responsible for
poor compliance to hand hygiene practices. Furthermore, lack of time management skills
were cited as another primary reason for poor compliance to the infection control practices.
Hence, it can be ascertained from the research that adhering to proper hand hygiene practices
in healthcare settings will prevent the spread of deadly pathogens and will also enhance the
health and wellbeing of the patients, staff and the family members of the service users.
Owing to the fact that poor infection control is related to increased mortality rates, influenza,
diarrhoeal and respiratory infections, introduction of this behavioural change that would
make it mandatory to wash hands at regular intervals will act as the most inexpensive and
effective way of preventing the spread of germs. Use of soap and detergents, solid soap,
antibacterial soap, and hand antiseptics will kill the pathogens and prevent all kinds of
detrimental effects on the human body.

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